Your Right to Know

WASHINGTON —Last month’s Supreme Court ruling that upheld President Barack Obama’s 2010
health-care law could save the U.S. government about $84 billion over 11 years, the nonpartisan
Congressional Budget Office said yesterday.

The savings would come primarily from a portion of the ruling giving the states an escape hatch
from the law’s expanded program of health-care coverage for the poor. That expansion of the
Medicaid program would be funded mostly by the federal government, but eventually states would have
to pick up a part of the cost.

The CBO also estimated that 3 million uninsured people who would have received Medicaid coverage
under the law before the ruling now will remain with no insurance. The law, considered Obama’s
signature domestic-policy achievement, aimed to extend medical coverage to more than 30 million
uninsured Americans.

It’s the first in-depth look by nonpartisan experts since the Supreme Court upheld most of the
law last month.

The United States pays more for health care than any other country, but about 50 million of the
roughly 310 million Americans still have no insurance at all.

A number of states have balked at the law’s Medicaid-expansion requirements, and any that decide
to limit their coverage or opt out would get less federal money and see their rates of uninsured
rise.

The CBO estimated that about 6 million fewer people than anticipated will be covered by Medicaid
as a result of states opting out, lowering the overall cost to the federal government.

Some of those people — about 3 million, according to the CBO — will end up purchasing insurance
on state health-insurance exchanges due to be established by 2014 under the law. The rest will go
without health insurance, according to the CBO.

Those who purchase health-insurance plans on the exchanges would be eligible for federal
subsidies, and that would increase the government’s costs. But the CBO said the Medicaid savings
would be greater than the added cost of covering people through plans offered on the insurance
exchanges.

The CBO also said that repealing the health-care law — a move advocated by Republicans — would
increase the deficit over the next decade by $109 billion. The law’s revenue increases and spending
cuts total more than the cost of expanding coverage to the uninsured, the CBO said.

The latest measure of the health-care law’s cost may add fuel to the debate over its merits
ahead of the Nov. 6 presidential election.

Senate Majority Leader Harry Reid said the CBO report will help Democrats highlight benefits of
a law that Republicans say is costly and is discouraging employers from hiring.

The congressional budget analysts estimated that the net cost of expanding medical coverage
under the law will total $1.168 trillion over the next 10 years, compared wih an earlier estimate
of $1.252 trillion.

In its ruling last month, the Supreme Court upheld the constitutionality of the so-called
individual mandate, requiring Americans to obtain health insurance by 2014 or face a tax
penalty.

But the court said the federal government could not compel states to expand their existing
Medicaid programs by threatening to disqualify them entirely from the costly coverage. The CBO said
its latest estimate reflects the belief that some states will limit their expansion of
Medicaid.